What is Diabetic Ketoacidosis?

Diabetic ketoacidosis (DKA) is a complication, which occurs in people with diabetes. Diabetes is a metabolic disorder characterised by abnormally high levels of blood sugar (glucose).Diabetes is caused due to a lack of insulin or the resistance of the cells to insulin. The hormone insulin helps the cells of the body to use glucose in the blood for energy and keeps the blood glucose under control. Lack of insulin (absolute resistance of the cells to insulin) prevents the entry of glucose in the cells. This results in the rise of blood glucose levels (hyperglycemia or high level ofglucose in the blood).
Cause of Diabetic ketoacidosis: Diabetic ketoacidosis occurs when the blood glucose is not used because there is an absolute loss of o insulin or not enough insulin. When the cells  are deprived of glucose because of lack of insulin, the liver makes more glucose and tries to combat the problem thereby, leading to an excess of sugar in the blood (usually higher than 300 mg/dL), which the cells are unable to use because of the lack of insulin.

The cells in the body use fat as fuel. Use of fat leads to the formation of a fat breakdown product called ketones and a rise in the blood levels of ketones causes diabetic ketoacidosis. In high levels, ketones are toxic to the cells in the body.

Symptoms of Diabetic ketoacidosis: Diabetic ketoacidosis (DKA) can be first sign or presenting symptom in some cases of type 1 diabetes (before diabetes is diagnosed or they have any other symptoms). It occurs most often in people with type 1 diabetes. Some common symptoms of DKA include:

• Deep and rapid breathing.
• Dry skin and mouth.
• Nausea and vomiting.
• Pain in abdomen.
• Flushed face.
• Breath with fruity smell.

In people with type 1 diabetes, Diabetic ketoacidosis can occur after an infection, injury, a serious illness, surgery or missing doses of insulin. DKA can occur in people with type 2 diabetes as well but it is rare. In type 2 diabetes, it may occur after severe illness.

Diagnosis of Diabetic ketoacidosis : If the doctor suspects DKA, blood and urine tests for ketone and sugar levels are done. To screen for early ketoacidosis in people with type 1 diabetes, ketones test is done using a urine sample. The doctor may recommend ketone testing in a person with type 1 diabetes:

• If the blood sugar is higher than 240 mg/dL.
• During an illness such as pneumonia, heart attack or stroke.
• If you have nausea or vomiting.
• During pregnancy.

Several other tests are done in people with ketoacidosis. The doctor will recommend the tests that are needed depending on your body’s chemistry.

Treatment of Diabetic ketoacidosis: Treatment for DKA aims to correct the level of blood sugar with insulin and replace fluids lost through urination and vomiting. DKA is mostly treated in the hospital, where the following is/will be done:

• Insulin replacement to correct blood glucose levels.
• Fluid and electrolyte replacement (to correct dehydration and imbalance of electrolytes in the body).
• Treat the cause of DKA (such as infection, injury etc).

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